Healthcare Provider Details

I. General information

NPI: 1902887342
Provider Name (Legal Business Name): JOSEPH MICHAEL REILLY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2005
Last Update Date: 01/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1733 HOWELL RD
HAGERSTOWN MD
21740-6638
US

IV. Provider business mailing address

1733 HOWELL RD
HAGERSTOWN MD
21740-6638
US

V. Phone/Fax

Practice location:
  • Phone: 301-797-2525
  • Fax: 301-797-5519
Mailing address:
  • Phone: 301-797-2525
  • Fax: 301-797-5519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberD0029302
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberD0029302
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: